Pain mitigation in pancreatic adenocarcinoma: A long-term analysis of denervation via transvascular RF energy-based ablation.

693 Background: The purpose of this study was to develop and implement a procedure to reduce severe pain from pancreatic cancer due to overactive sympathetic nerve activity using transvascular radiofrequency (RF) nerve ablation. Methods: 20 patients with severe abdominal pain from unresectable pancreatic cancer were enrolled and 19 treated with transvascular energy. Angio-CT/MRI were used to assess the tumor and plan the procedure. After accessing the vessel through a standard transfemoral or transbrachial approach, transvascular RF energy was delivered via catheter sequentially to multiple sites, including the celiac trunk, common hepatic artery, and/or splenic artery. All treated patients were evaluated within 24 hours, after 24 hours, 7 days, 4-6 weeks, and 3-months post-procedure for the following outcomes: adverse events, pain severity (VAS, 1-10), quality of life assessment (EORTC-30, 0-7), and opioid use. Results: Responding femoral patients (N=16) represented 84% of treated patients with a mean pain reduction of 4.16 on the VAS pain scale (baseline of 7.81 to 3.65), or 53.3% improvement, at 7-days post-procedure. At 4-6 weeks post-procedure, responding patients (N=9) reported a mean 4.67 reduction on the VAS pain scale (baseline of 7.89 to 3.22), or 59.2% improvement. 100% of responding patients were at zero opioid use at 7-days post-procedure, while 73% of responding patients (N=11) were at zero opioid use at 4-6 weeks post-procedure. In a post hoc analysis, pain reduction remained consistent at 3 months post-procedure, where surviving patients in the responder group (N=6) reported a mean pain reduction of 5.08 (baseline 7.75 to 2.67) or 65.6% improvement. In addition to lasting pain relief, all responding patients (N=6) experienced remarkable improvement in global health (mean 76.5% improvement), functional ability (mean 51.5% improvement), and symptom management (mean 50.4% improvement). Additionally, 100% of responding patients (N=7) were opioid free at their 3-month post-procedure follow-up which highlights the potential for a non-opioid alternative in a highly opioid-reliant disease. This procedure therefore has the potential to provide clinically significant and long-term pain relief, reduce the dependence on opioids for pain management, and improve day-to-day living during end-stage cancer. There were no device or procedure-related serious adverse events. The number of patients decreased over time due to natural disease progression, including deaths unrelated to the procedure or device. Conclusions: RF ablation of the somatosensory nerve via a transfemoral approach to the celiac plexus showed significant pain relief, improved quality of life, and reduced opioid use. These promising feasibility results prove that transvascular RF nerve ablation is both safe and effective in reducing severe pain from pancreatic carcinoma.